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In recent years, there has been a resurgence of interest in developing green and renewable alternate energy sources as a solution to the energy and environmental problems produced by conventional fossil fuel use.

In the present study, we consider the problem of missing and extreme values for the estimation of population variance. The presence of extreme values either in the study variable, or the auxiliary variable, or in both of them, can adversely affect the performance of the estimation procedure. We consider three different situations for the presence of extreme values and also consider jackknife variance estimators for the population variance by handling these extreme values under stratified random sampling. Bootstrap technique ABB is carried out to understand the relative relationship more precisely.

This article develops an almost unbiased estimation of coefficient of dispersion by the productive use of coefficient of dispersion of the auxiliary variable in two phase sampling. Expressions for variances of the proposed estimators are obtained up to first order of approximation. The relative efficiencies of proposed unbiased ratio estimator are compared with navie estimator by using simulated data sets. Thus, we conclude that the proposed imputation procedure is more efficient than traditional estimator.

Aim: To audit the breast cancer surgeries and to establish the age groups and stage at which breast cancer patients present in our institution. Study design: Retrospective study Place and duration of study: Department of Surgery, Jinnah Hospital, Lahore from January 1st 2017 to December 31st 2021. Methodology: Four hundred and seventy-one breast cancer patients were sorted out. The data included the stage of presentation of breast cancer, age at presentation, year of presentation, gender and surgeries performed according to stage of carcinoma of breast. Results: The patient of breast carcinoma usually presents for medical help in her forties (31%) while patients presented between 18 to 86 years of age. Most patients however presented in stage III. Frequent sentinel lymph node biopsies with breast conservation surgery. All stage III breast carcinoma patients were treated with MRM and level II axillary clearance. BCS with sentinel lymph node biopsy was done for early breast cancer. Conclusion: Carcinoma of breast presents in earlier age in Pakistan as compared to West. Despite limited resources and non-compliant patient population, we are striving to provide standard treatment to all breast cancer patients. Increase in sentinel lymph node biopsies instead of axillary clearance shows this expedition. Keywords: Breast conservation with sentinel biopsy, Stage, Age

Motivated by Haq et al. (2017), Mohamed et al. (2018) and some recent developments for the estimation of finite population mean, we propose a new design based imputation procedure for the imputatio...

In the current pandemic, the global consensus between all stakeholders is the basic key to achieve success against COVID-19. In the last few months, global discrimination toward COVID-19 vaccine has continually been observed from the world's leading stakeholders and that has led to instability toward the acceptability of COVID-19 vaccine.

COVID-19 has big health issues which affect worldwide beyond their borders, race, and ethnicity. All the countries faced this pandemic challenge but most of the underdeveloped countries are facing more dangerous situations due to limited financial and health infrastructure to respond against it. Overall, more than 100 million people are affected by the Novel Virus which results in 2.15 million people dying within a small interval of time. The current pandemic has brought unpredicted challenges to societies and also threatened humanity and global resilience. According to the National Command Operation Center, Pakistan, more than 0.534 million people are suffering with COVID-19 with more than 11 thousand deaths across the country. The Government of Pakistan has taken different initiatives like complete and smart lockdown to control the pandemic as much as possible. After the removal of the first lockdown, the high peak was observed across the country and created a panic situation among people and the government again closed all the educational and religious institutions with immediate effect to tackle the second wave of pandemic. Further, the interconnected nature of COVID-19 crises demands an integrated approach and coordination between all stakeholders to handle the pandemic in a significant way. Identifying the best set of policies and guidelines to handle COVID-19 challenges, and align them for the sustainable recovery from pandemic. The basic challenge facing the policy makers of underdeveloped countries is how to utilize limited resources to achieve interconnected goals for managing health recovery, economic crises, and creating environmental sustainability. We present a framework for identifying and prioritizing policy action to address COVID-19 and ensure sustainable recovery. The framework outlines principles and criteria, and shared policy goals, identifying smart strategies, accessing policy compatibility, aligning policy instruments and improving sustainability in short and long term policy decisions. This framework can be helpful for policy makers in the short and long run for mapping policy options and accessing cross-sectoral implementation. This framework is also helpful for policy makers to prioritize policy choice and allocate limited resources in such a way that they are directed toward actions and achieve interconnected solutions of health, economy, and environment.

Eosinophilic gastrointestinal disorders represent a spectrum of disorders demonstrating gastrointestinal eosinophilia without any known cause for eosinophilia. Pathogenesis is not clearly established, but immune responses to dietary antigens are implicated. These disorders affect children and adults and are seen in association with allergic disorders. Eosinophilic esophagitis is diagnosed in the setting of mucosal eosinophilia on endoscopic biopsy and symptoms of esophageal dysfunction. Eosinophilic gastroenteritis is also diagnosed with endoscopic biopsies. Eosinophilic colitis commonly presents with lower gastrointestinal symptoms and is a diagnosis of exclusion.

In this paper, we consider the problem of missing complete at random (MCAR) values in two-phase probability proportional to size ( pps) sampling for the estimation of population mean. For comprehensive examination of missing values, we discuss four possible situations for the occurrence of non-response. A class of estimators is considered by using an unknown constant with the traditional estimators for imputing the missing values. Theoretically, bias and mean squared errors of the proposed estimators are obtained up to the first order approximation. Two numerical studies are carried out for the relative comparison of the proposed estimators with mean estimator under two-phase ppssampling for each of the predefined situation.

Background: Medical practitioners are the main source of health care forpatients in Pakistan due to their availability at all times. Limited information is available related tothe management of Tuberculosis (TB) among the practitioners. Study Design: Cross sectionalstudy. Setting: Through stratified random sampling among the practitioners of Lahore, Punjab.Period: May 2014 to August 2014. Methods: They were presented with a questionnaire andtheir answers examined according to the international designed strategy for TB management.Results: TB management has a positive relationship with experience, awareness, source ofawareness and continuing medical education and a negative relationship with qualification. 95% of doctors agreed to go for further investigation but only 40% knew that 2 sputum sampleswere required for proper diagnosis. Only 32% doctors knew TB resistant drugs were to begiven in drug resistant cases. Conclusion: Most doctors in Pakistan lack sufficient knowledgeregarding tuberculosis management and prompt measures shall be taken to improve it.

Antiarrhythmic drugs are commonly prescribed cardiac drugs. Due to their receptor mimicry with several of the gastrointestinal tract receptors, they can frequently lead to gastrointestinal side effects. These side effects are the most common reasons for discontinuation of these drugs by the patients. Knowledge of these side effects is important for clinicians that manage antiarrhythmic drugs. This review focuses on the gastrointestinal side effects of these drugs and provides a detailed up-to-date literature review of the side effects of these drugs. The review provides case reports reported in the literature as well as possible mechanisms that lead to gastrointestinal side effects.

The estimation of population parameters might be quite laborious and inefficient, when the sample data have missing values. In comparison follow-up visits, the method of imputation has been found to be a cheaper procedure from a cost point of view. In the present study, we can enhance the performance of imputation procedures by utilizing the raw moments of the auxiliary information rather than their ranks, especially, when the ranking of the auxiliary variable is expensive or difficult to do so. Equations for bias and mean squared error are obtained by large sample approximation. Through the numerical and simulation studies it can be easily understood that the proposed method of imputation can outperform their counterparts.

Aim To compare bleeding within 48 h in patients undergoing percutaneous endoscopic gastrostomy (PEG) with or without clopidogrel. Methods After institutional review board approval, a retrospective study involving a single center was conducted on adult patients having PEG (1/08-1/14). Patients were divided into two groups: Clopidogrel group consisting of those patients taking clopidogrel within 5 d of PEG and the non-clopidogrel group including those patients not taking clopidogrel within 5 d of the PEG. Results Three hundred and nineteen PEG patients were found. One hundred and sixty-eight males and 151 females with mean body mass index 28.47 ± 9.75 kg/m(2) and mean age 65.03 ± 16.11 years were identified. Thirty-three patients were on clopidogrel prior to PEG with 286 patients not on clopidogrel. No patients in either group developed hematochezia, melena, or hematemesis within 48 h of percutaneous endoscopic gastrostomy (PEG). No statistical differences were observed between the two groups with 48 h for hemoglobin decrease of > 2 g/dL (2 vs 5 patients; P = 0.16), blood transfusions (2 vs 7 patients; P = 0.24), and repeat endoscopy for possible gastrointestinal bleeding (no patients in either group). Conclusion Based on the results, no significant post-procedure bleeding was observed in patients undergoing PEG with recent use of clopidogrel.

Background In patients suffering from upper gastrointestinal bleeding (UGIB), adequate visualization is essential during endoscopy. Prior to endoscopy, erythromycin administration has been shown to enhance visualization in these patients; however, guidelines have not fully adopted this practice. Thus, we performed a comprehensive, up-to-date meta-analysis on the issue of erythromycin administration in this patient population. Methods After searching multiple databases (November 2015), randomized controlled trials on adult subjects comparing administration of erythromycin before endoscopy in UGIB patients to no erythromycin or placebo were included. Pooled estimates of adequacy of gastric mucosa visualized, need for second endoscopy, duration of procedure, length of hospital stay, units of blood transfused, and need for emergent surgery using odds ratio (OR) or mean difference (MD) were calculated. Heterogeneity and publication bias were assessed. Results Eight studies (n=598) were found to meet the inclusion criteria. Erythromycin administration showed statistically signifi cant improvement in adequate gastric mucosa visualization (OR 4.14; 95% CI: 2.01-8.53, P

Alcoholic hepatitis is a form of severe, cholestatic liver disease that results from consumption of large amount of alcohol during a sustained period of time in a subset of alcoholics. Symptoms could be mild and nonspecific to more severe. The diagnosis of alcoholic hepatitis can be made with a thorough history, physical examination, and review of laboratory results. Liver biopsy is confirmatory but generally not indicated for the diagnosis. Abstinence is the key form of therapeutic intervention. Despite variable results in clinical trials, corticosteroids and pentoxifylline seem to provide moderate survival benefit. Liver transplantation in acute alcoholic hepatitis is contentious.

Isolated spontaneous dissection of the celiac artery is rare, and its occurrence without aortic dissection is even rarer. The typical symptom of this dissection is acute-onset abdominal pain. Complications of the condition include aneurysm formation, rupture, and abdominal-organ ischemia or infarction, especially in the liver or spleen. We report the case of a 47-year-old man with von Willebrand disease who had an isolated spontaneous dissection of the celiac artery. We used computed tomography and computed tomographic angiography in the diagnosis and characterization of the dissection. To our knowledge, this is the first report of celiac artery dissection in a patient with von Willebrand disease.